Endoscopic Cervical Lymph Node Dissection Using the Extra-cervical Anterior Chest Wall Approach: A New Technique

Area of Science:

• Surgical Oncology
• Minimally Invasive Surgery
• Head and Neck Surgery

Background:

• Conventional neck dissection often results in visible scarring.
• Endoscopic techniques offer potential for improved aesthetics and reduced morbidity.
• The anterior chest wall approach (ACWA) presents a novel route for endoscopic neck dissection (END).

Purpose of the Study:

• To evaluate the safety, surgical feasibility, and esthetic outcomes of total endoscopic neck dissection (END) using an anterior chest wall approach (ACWA).
• To assess the technique's efficacy in head and neck cancer patients without requiring neck incisions.

Main Methods:

• Six patients with biopsy-proven head and neck carcinoma underwent primary tumor resection followed by selective total END.
• The procedure utilized an ACWA with three ports: one 10-mm for the camera and two 5-mm for instruments.
• No conversion to open surgery was required; visualization of neurovascular structures was consistently good.

Main Results:

• Successful endoscopic completion in all cases with operative times of 120-170 minutes and minimal blood loss (10-50 mL).
• Average of 13.67 lymph nodes retrieved per patient, with a low lymph node ratio (LNR).
• No significant perioperative complications; patients discharged on postoperative day 3 with high satisfaction regarding cosmetic results.

Conclusions:

• Total END via ACWA is technically feasible, safe, and yields satisfactory cosmetic outcomes, notably avoiding neck scars.
• Magnification of critical neurovascular structures is a key advantage of this endoscopic approach.
• While promising, further research with longer follow-up is necessary to confirm oncological safety and long-term benefits.